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Micro-Finance Bank Code …………….

Micro-Finance Bank Name ABC Microfinance Bank Limited


Return Code : Form MMFBR 300
Return Name Monthly Statement of Assets and Liabilities
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

Code Item Description Amount N’000 Amount N’000


10000 ASSETS
10100 CASH:
10110 Notes
10120 Coins
10130 Total Cash -
10200 DUE FROM:
10210 Banks in Nigeria:
10220 Balances with Banks (Specify, MMFBR 221) - -
10300 Placements
10310 Secured with Treasury Bills (Specify, MMFBR 311) -
10320 Unsecured (Specify, MMFBR 321) -
10330 Total Placement with Banks/Discount Houses -
10400 Total Due From
10500 SHORT TERM INVESTMENTS:
10510 Treasury Bills -
10600 LONG-TERM INVESTMENTS:
10610 Quoted Companies
10620 Unquoted Companies
10630 Subsidiary Companies
10640 Others (Specify, MMFBR 641) -
10650 Total Long-Term Investments -
10700 LOANS AND ADVANCES/LEASES
10710 Micro Loans (Specify, MMFBR 711) -
10720 Small and Medium Enterprises Loans
10725 Bills Discounted
10730 Hire Purchase
10740 Advances Under Micro-Leases
10745 Other Loans (Specify, MMFBR 746) -
10750 Staff Loans
10760 Total Loans and Advances/Leases -
10770 Specific Loan/Lease Loss Provision (Specify, MMFBR 771) -
10780 General Loan/Lease Loss Provision -
10790 Total Loan/Lease Loss Provision -
10795 Net Loans and Advances
10800 OTHER ASSETS:
10810 Total Other Assets (Specify, MMFBR 811) -
10880 Provision for Losses on Other Assets
10890 Other Assets (Net) -
10900 FIXED ASSETS
10910 Freehold Land and Building
10920 Leasehold Land and Building
10930 Plant and Machinery
10940 Furniture and Fixtures
10950 Motor Vehicles
10960 Office Equipment
10970 Total Fixed Assets -
10980 Less Accumulated Depreciation -
10990 Net Fixed Assets
11000 TOTAL ASSETS

LIABILITIES
20100 DEPOSITS:

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20110 Demand Deposits
20120 Mandatory Deposits
20125 Voluntary Savings Deposits
20130 Time/Term Deposits
20140 Other Deposits (Specify, MMFBR 141) -
20200 Total Deposits -
20300 TAKINGS FROM:
20310 Banks in Nigeria (Specify, MMFBR 312) -
20320 Other Institutions (Specify, MMFBR 322) -
20330 Total Takings -
20450 Re-financing Facilities (Specify, MMFBR 451) - -
20500 Other Liabilities (Specify 501) - -
20600 BORROWINGS (On-lending):
20610 Federal Government
20620 State Government
20630 Local Government
20640 Foreign Agencies (Specify, MMFBR642) -
20650 Others (Specify, MMFBR 651) -
20660 Total Borrowings -
20700 DEBENTURE/LOAN STOCK:
20710 Redeemable Debenture
20720 Irredeemable Debenture
20750 Total Debentures/Loans Stock -
20800 CAPITAL
20810 Authorised Share Capital -
20820 Issued & Fully Paid-up Capital:
20830 Ordinary Shares
20840 Preference Shares
20860 Total Capital -
20900 RESERVES:
20910 Statutory Reserve
20920 Share Premium
20930 General Reserve
20932 Deferred Grants/Donations Reserves (Specify, MMFBR 933) -
20935 Bonus Reserves
20940 Revaluation Reserves
20950 Other Reserves (Specify, MMFBR 951) -
20960 Retained Profit/(Loss)
20965 Unaudited Loss to date
20970 Total Reserves -
20980 TOTAL CAPITAL & RESERVES
20990 TOTAL LIABILITIES
Accuracy Check
20995 OFF-BALANCE SHEET ENGAGEMENTS (Specify, MMFBR 996)

……………………………………………….. …………………………………………………….
AUTHORISED SIGNATORY AUTHORISED SIGNATORY
In the event of a query, Other Financial Institutions Department may contact: (block letters please)

NAME: ……………………………………………………………………………… Tel No. …………………………………..

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Amount N’000

-
-

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-

-
-
-

-
-

……………..

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 1000
Return Name Monthly Statements of Profit and Loss Account
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

CODE Item Description Amount N’000

30000 Interest Income


30100 Less : Interest Expenses
30110 Net Interest Income
30200 Other Income:
30210 Commission
30220 Fees/Charges
30230 Income From Investments
30240 Other Income From Non-Financial Services
30250 Total Other Income
30300 Net Income
31000 Operating Expenses:
31100 Staff Cost
31110 Directors
31120 Remuneration
Depreciation
And Expenses
31130 Provision For Bad Debts
31140 Bad Debts Written-Off
31150 Penalties Paid
31160 Overheads
31170 Total Operating Expenses:
31180 Profit/(Loss) Before Tax
31190 Less : Provision For Taxation
31200 Profit/(Loss) After Tax
31210 Extra Ordinary Items (EOI)
31220 Tax On EOI
31230 Profit/(Loss) On EOI After Tax
31240 Profit/(Loss) After Tax & EOI

…………………………………… …………………………………………….
AUTHORISED SIGNATORY AUTHORISED SIGNATORY
In the event of a query, Other Financial Institutions Department may contact: (block letters please)

NAME: ……………………………………………………………………………… Tel No.

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Amount N’000 Amount N’000

-
-

- -
-
- -
-

- -
-

…………………………………………….
AUTHORISED SIGNATORY
act: (block letters please)

…………………………………..

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : MMFBR M001
Return Name Memorandum Items
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

Current Month Cummulative to Date


Number Value (N'000) Number Value (N'000)
21100 Total New Loans Disbursed
21110 Borrowers: - - - -
21111 Female
21112 Male
21120 Clients Drop-outs: - - - -
21121 Female
21122 Male
21130 Depositors: - - - -
21131 Female
21132 Male
21140 MALE FEMALE MALE FEMALE
21141 Senior Staff
21142 Junior Staff
21145 Total Staff - - - -
Number of Loan officers
21146 Staff Resigned, Terminated, Dismissed etc in the
Month (Specify)
21147 New Recruitments in the Month (Specify)

21150 Date of Last CBN/NDIC Examination


21151 Recommended Provision as at Last Examination

21160 Financial Year End


21170 Number of Branches in Operation:
21171 Existing:
21172 New
21173 Closed
21174 Number of Cash Centres
21175 Number of Meeting Points

…………………………………… …………………………………………….
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 221
Return Name Schedule of Balances Due from other Banks in Nigeria
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

AMOUNT
BANK’S CODE NAME OF BANK N’ 000

TOTAL -

…………...………………………………….. …………………………………………………
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 311
Return Name Schedule of Secured Placements with Banks/Discount Houses
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

BANK’S CODE NAME OF BANK TENOR MATURITY DATE AMOUNT N'000

Total Amount -

……………………………………………… ……………………………………………………………………………….
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 321
Return Name Schedule of Unsecured Placements with Banks/Discount Houses
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

BANK’S CODE NAME OF BANK TENOR MATURITY DATE AMOUNT N'000

TOTAL -

…………………………………………….. …………………………………………………
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 641
Return Name Schedule of Other Long-term Investments
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

BANK’S CODE NATURE OF INVESTMENTS AMOUNT N’ 000

TOTAL -

………………………………………….. ……………………………………………………
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 711
Return Name Schedule of Micro Loans by Lending Models
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

S/N LENDING MODEL NUMBER AMOUNT (N'000) %


1 Individuals #DIV/0!
2 Solidarity Group #DIV/0!
3 Neighborhood and Small Group #DIV/0!
Revolving Funds
4 Village Banking #DIV/0!
5 Wholesale lending #DIV/0!
6 Credit Unions #DIV/0!
7 Staff #DIV/0!
8 Others - Specify #DIV/0!
Total - - #DIV/0!

………………………………….. …………………………………………
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 746
Return Name Breakdown of Other Loans
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

……………………………………………… …………………………………………………….
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

Total Amount N'000 -


S/N Names of Beneficiary Date Facility Granted Tenor Amount Approved Outstanding Balance Status of Facility
N'000 N'000

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-

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 761
Return Name Summary of Loan Classification
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

S/N AMOUNT (N'000)


10762 Performing
10763 Non-Performing (Portfolio-At-Risk)
10764 Pass & Watch -
10765 Substandard -
10766 Doubtful -
10767 Lost -
10768 Total Porfolio-At-Risk -
Interest In Suspense -
10769 Total -

………………………………………………….. …………………………………………………..
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 771
Return Name Summary of Non Performing Loans
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

…………………………………………………………... ………………………………………………………...
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

Total Amount N'000 0 0 0 0 0 0 0 0


1 2 3 4 5 6 7 8 9 10
S/No. Customer Code Customer's Name Past Due Date Last date of Total Credit Principal Accrued Total non Bank’s classification
Repayment N'000 Payment Interest performing credits 10a. 10b. 10c. 10d.
Due & unpaid
Unpaid N'000 1 - 30 days 31-60 days 61-90 days 91 or More
Pass & Watch Sub-Standard Doubtful Lost
N'000 N'000 N'000 N'000
N'000
N'000 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

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0
11 12
Bank's Provision Remarks
N'000

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

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0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

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0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 762
Return Name Sectoral Analysis of Loans and Advances
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

SECTOR NUMBER OF AMOUNT %


LOANS (N'000)
Agriculture & Forestry #DIV/0!
Mining & Quarry #DIV/0!
Manufacturing & Food Processing #DIV/0!
Trade & Commerce #DIV/0!
Transport & Communication #DIV/0!
Real Estate & Construction #DIV/0!
Rent/Housing #DIV/0!
Consumer/Personal #DIV/0!
Health #DIV/0!
Education #DIV/0!
Tourism & Hospitality #DIV/0!
Purchase of Shares #DIV/0!
Others (Specify) #DIV/0!
TOTAL - - #DIV/0!

……………………………………………………. …………………………………………………….
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Name Schedule of Loans Structure and Maturity Profile
Return Code : Form MMFBR 763
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

TYPE OF LOANS 1 - 30 Days 31 - 60 Days 61 – 90 Days 91 – 180 Days 181 – 360 Days Above 360 TOTAL %
N'000 N'000 N'000 N'000 N'000 Days N'000 N'000

MICRO-LOANS
Number of accounts - #DIV/0!
Amount (N) - #DIV/0!
SMALL & MEDIUM ENTERPRISES LOANS
Number of accounts - #DIV/0!
Amount (N) - #DIV/0!
HIRE PURCHASE
Number of accounts - #DIV/0!
Amount (N) - #DIV/0!
MICRO-LEASES
Number of accounts - #DIV/0!
Amount (N) - #DIV/0!
OTHER LOANS (SPECIFY)
Number of accounts - #DIV/0!
Amount (N) - #DIV/0!
STAFF LOANS
Number of accounts - #DIV/0!
Amount (N) - #DIV/0!
TOTAL
Number of accounts - - - - - - - #DIV/0!
Amount (N) - - - - - - - #DIV/0!

…………………………………………………….. ……………………………………………………..
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 764
Return Name Schedule of Interest Rates
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

TYPE OF ACCOUNT 0 – 30 Days (%) 31 – 60 61 – 90 days(%) 91 – 180 days(%) 180 – 360 Over 360
Days(%) Days(%) days(%)
Loans and Advances
Hire Purchase
Micro-Leases
Savings Deposits
Time/Term Deposits
Target Deposits

…………………………………… …………………………………………….
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 811
Return Name Schedule of Other Assets
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

PERFORMING NON-PERFORMING TOTAL


CODE ITEM
N’ 000 N’ 000 N’ 000
10815 Accounts Receivable - Provide Breakdown
10820 Accrued Interest Receivable (Specify) - Provide Breakdown
10825 Cheques for Collection /Transit Items -
10835 Prepaid Interest - Provide Breakdown
10840 Prepaid Rent -
10845 Stationery -
10850 Other Prepayments - Provide Breakdown
10855 Suspense Account - Provide Breakdown
10860 Goodwill and Other Intangible Assets - Provide Breakdown
10865 Miscellaneous (Specify) - Provide Breakdown
TOTAL - - -

Note: Please provide a breakdown of any item that is equal to or greater than 10% of Total Other Assets.

…………………………………………. ……………………………………………………………
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 141
Return Name Schedule of Other Deposits
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

S/N TYPE OF DEPOSIT TOTAL


N'000

……………………………………… ………………………………………………………………
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 201
Return Name Schedule of Deposit Structure and Maturity Profile
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

TYPE OF DEPOSITS 1 - 30 Days 31 - 60 Days 61 – 90 Days 91 – 180 Days 180 – 360 Days Above 360 Days TOTAL %
N'000 N'000 N'000 N'000 N'000 N'000 N'000

DEMAND DEPOSITS
Number of accounts - #DIV/0!
Amount (N) - #DIV/0!
MANDATORY SAVINGS
Number of accounts - #DIV/0!
Amount (N) - #DIV/0!
VOLUNTARY SAVINGS
Number of accounts - #DIV/0!
Amount (N) - #DIV/0!
TERM/TIME DEPOSITS
Number of accounts - #DIV/0!
Amount (N) - #DIV/0!
SPECIAL DEPOSITS
Number of accounts - #DIV/0!
Amount (N) - #DIV/0!
OTHER DEPOSITS (SPECIFY)
Number of accounts - #DIV/0!
Amount (N) - #DIV/0!
TOTAL
Number of accounts - - - - - - - #DIV/0!
Amount (N) - - - - - - - #DIV/0!

…………………………………………………….. ……………………………………………………..
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 202
Return Name Schedule of Insured Deposit
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

S/N TYPE OF DEPOSITS N1 - N100,000 N100,001 & Above

1 DEMAND DEPOSIT
Number of accounts
Amount (N)
2 SAVINGS DEPOSIT
Number of accounts
Amount (N)
3 TERM/TIME DEPOSIT
Number of accounts
Amount (N)
4 SPECIAL/OTHER DEPOSITS
Number of accounts
Amount (N)
TOTAL
Number of accounts - -
Amount (N) - -

…………………………………………………….. ……………………………………………………
AUTHORISED SIGNATORY AUTHORISED SIGNATORY
TOTAL N'000

-
-

-
-

-
-

-
-

-
-

………………………………………..
THORISED SIGNATORY
Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 312
Return Name Schedules of Takings From Banks in Nigeria
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

Bank's Code Name of Banks Rate Tenor Effective Date Maturity Date Amount
N'000

Total -

…………………………………………………... …………………………………………………...
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 322
Return Name Breakdown of Takings From Other Institutions
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

Bank's Code Name of Institution Rate Tenor Maturity Date Amount


N'000

Total -

…………………………………………………………………………………. …………………………………………………………….
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 451
Return Name Schedule of Re-financing Facilities
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

Bank's Code Name of Institution Rate Tenor Maturity Date Amount


N'000

Total -

……………………………………………. …………………………………………………………….
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 501
Return Name Schedule of Other Liabilities
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

CODE ITEM N’ 000


20510 Accounts Payable Provide Breakdown
20515 Unearned Income Provide Breakdown
20520 Interest Accrued Not Paid Provide Breakdown
20525 Uncleared Effects / Transit items
20530 Un-audited Profit to Date -
20535 Provision for Diminution in the Value of Investments
20540 Provision for Losses on Off-Balance Sheet Items
20545 Interest-in-Suspense
20550 Provision for Taxation
20555 Provision for Other Known Losses
20560 Dividends Payable
20565 Suspense Account Provide Breakdown
20570 Deposit for Shares
20575 Miscellaneous (Specify) Provide Breakdown
Total -

Note: Please provide a breakdown of any item that is equal to or greater than 10% of Total Other Liabilities.

……………………………………………….. ……………………………………………………
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 642
Return Name Schedule of Borrowings from Foreign Agencies
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

S/N Name of Lending Institution Country Date Effective Date Tenor Amount Granted
Facility N'000
Granted

Total -

………………………………………………….. …………………………………………………………
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 651
Return Name Schedule of Borrowings from Other Agencies
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

S/N Name of Lending Institution Country Date Facility Tenor Amount Granted
Granted N'000
-
-
-
-
-
-
-
-
-
Total -

…………………………………………….. …………………………………………………
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 933
Return Name Schedule of Deferred Grants & Donation Reserves
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

S/N Name of Institution Country Purpose Total Amount Outstanding Amount


N'000 Deferred Transferred to
Grants/Donations General
Amount Reserves
N'000 N'000

Total - - -

………………………………………… ………………………………………………………………………..
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : From MMFBR 951
Return Name Schedule of Other Reserves
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

S/N ITEM AMOUNT


N'000

TOTAL -

……………………………………….. …………………………………………………….
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 996
Return Name Schedule of Contra Items
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

S/N ITEM DESCRIPTION AMOUNT


N'000

TOTAL -

…………………………………… …………………………………………….
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Code : Form MMFBR 980
Return Name Gap Analysis
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

Total Amount N’000


ITEMS 1 2 3 4 5 6 7
1 – 30 Days 31 – 60 Days 61 – 90 Days 91 – 180 Days 180 – 360 Days > 360 Days Total

Loans -
Investments -
Other Assets -
Total (A) - - - - - - -
Deposits -
CDs and Other Liabilities -
Total (B) - - - - - - -
Equity (C) -
Net Periodic Gap A - (B+C) - - - - - - -
Cumulative Gap - - - - - - -

Note :-
i. Net Periodic Gap = A minus B minus C
ii.                   Cumulative Gap Column 1 = Net Periodic Gap in Column 1
iii.                  Cumulative Gap in Column 2 = Net Periodic Gap in (Column 1 + Column 2)
iv.                  Cumulative Gap in Column 3 = Cumulative Gap in Column 2 + Net Periodic Gap in Column 3
v.                    Cumulative Gap in Column 4 = Cumulative Gap in Column 3 + Net Periodic Gap in Column 4 etc.

…………………………………… …………………………………………….
AUTHORISED SIGNATORY AUTHORISED SIGNATORY

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Micro-Finance Bank Code …………….
Micro-Finance Bank Name ABC Microfinance Bank Limited
Return Name ANTI-MONEY LAUNDERING AND KNOW YOUR CUSTOMER RETURNS
Return Code :
Reporting Date: 31/12/2009
State Name ………………………………………………………
State Code …………….
Local Government Name …………………………………………
Local Government Code …………………………..

YES NO
Have you rendered Anti-money Laundering and Know Your Customer Returns to the appropriate agencies?

…………………………………… …………………………………………….
AUTHORISED SIGNATORY AUTHORISED SIGNATORY
In the event of a query, Other Financial Institutions Department may contact: (block letters please)

NAME: Tel No.

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